Have You Lost Your Mind?

More bad news for boomers.

The cognitive test isn’t supposed to be a contest. Still, I did cheat—or I tried.Credit Illustration by Nishant Choksi

“Write about what you know,” the creative-writing teachers advise, hoping to avoid twenty-five stories about robots in love on Mars. And what could you know better than the inside of your own head?

Almost anything. And almost anyone else is better positioned than you are to write about the foreign land between your ears. You are the person least qualified to be writing about changes in your own brain, since you need your brain to comprehend those changes. It’s like trying to fix a hammer by using the hammer you’re trying to fix. Without getting into robots on Mars, I remember vaguely, from the nineteen-sixties, a comic-book tale about some residents of our three-dimensional world who go through a hole in space, or something like that, and find themselves living in two dimensions. “And nothing’s changed,” one says, triumphantly, unable to see what we can see: that he is now the approximate shape and depth of a postage stamp. Maybe this is what the descent into dementia is like: everyone around you knows or suspects you have it, but to yourself you seem the same.

The tsunami of dementia that is about to swamp us, as the baby boomers age, has got plenty of attention, but the reality has not sunk in. We stave it off with jokes: Ronald Reagan goes in for his annual physical and the doctor says, Mr. President, I have bad news and worse news. Reagan says, Lay it on me, Doc. The doctor says, The bad news is that you have cancer. Reagan: And the worse news? Doctor: You have Alzheimer’s. Reagan: Well, at least I don’t have cancer.

Go ahead and laugh, if you think that’s funny. (I do.) You’re just whistling past the nursing home. We make jokes about Alzheimer’s that we never would make about cancer—not because it’s the inherently funnier disease but precisely because it isn’t. Even a joke about Alzheimer’s and cancer is inevitably a joke about Alzheimer’s.

Cancer is dreadful, and I don’t want to challenge anyone to a round of you-think-you’ve-got-problems. And, to be clear from the start, at the cost of giving up some artificial tension and flashy foreshadowing: I don’t have Alzheimer’s, or any other form of dementia at the moment. But I do think about it. There is a special horror about the prospect of spending your last years shuffling down the perennially unfamiliar corridors of some institution in a demented fog, your diaper hanging loose, being treated like a child by your children, watching TV all day but unable to follow even the most simpleminded propaganda on Fox News or the most facile plot twist of “Downton Abbey.”

Dementia seems like an especially humiliating last stop on the road of life. There’s no way to do it in style or with dignity. And you can’t be sure that you’re going to avoid it until the moment something else, like cancer or a big, big truck, comes along to carry you off first.

Baby boomers—the seventy-nine million Americans born between 1946 and 1964—will be the second dementia generation, but the first to know that it’s coming. Our grandparents generally died too young or too poor to worry about what used to be called “senility.” They didn’t provide much in the way of foreboding for their children, who are our parents. For us, however—the boomers, now in our fifties and sixties—ways of dealing with infirm and often mentally impaired parents is one of the top five subjects of conversation. (Is that true? Let’s see: real estate, traffic, aged parents . . . yeah, I can only make it to three.)

By now there is an extensive literature, fiction and non-, about watching your parents lose their minds. (See Alex Witchel’s touching book “All Gone,” about the unravelling of her intelligent mother’s intelligence, for a current example. Or Roz Chast’s downright moving graphic essay in this magazine some weeks back.) There are books by and about people losing their own minds, too. But they tend to be rock stars or drug addicts or both, already famous for their dissipation. These are people who have some prior claim on your prurient interest—not real people whose experience can strike fear in your heart (or, rather, your brain) that “this could happen to me.”

Writing in these pages a few years ago, I predicted that the ultimate boomer rat race would be the competition to live the longest. I stand by my prediction that, as the moment approaches, dying richer will come to seem pointless compared with dying later. But, on further reflection, I think I underrated the penultimate boomer competition: competitive cognition. The rules are simple: the winner is whoever dies with more of his or her marbles.

“He was a hundred and two years old when he was accidentally shot by a neighbor, and, except for his habit of breaking into nearby homes and stealing the booze, he was still sharp as a tack.” That’s the kind of thing you want said about you. So “Death before dementia” is your rallying cry. It is also your best strategy, at the moment, since there’s no cure for either one.

Of the seventy-nine million boomers, fourteen million are expected to develop Alzheimer’s or some other form of dementia. (Alzheimer’s is the most common, followed by stroke, and the festively named dementia with Lewy bodies. Parkinson’s comes next.) That’s about eighteen per cent, and the only reason the number isn’t higher is that many people suffering from dementia die of something else first. Similarly, longer life is probably the only reason that women are more likely than men to suffer from dementia. (A sixty-five-year-old woman has a twenty-per-cent chance versus seventeen per cent for a sixty-five-year-old man.) Anyone who lives past eighty-five, as more and more of us intend to, has roughly a fifty-fifty chance of exiting by way of Alzheimer’s.

So there are two forms of competition in the boomer death-style Olympics. There’s dying last and there’s dying lucid. And, in a really nice touch by whoever designed these games, the better you do in one the worse you’re likely to do in the other. If you’re prepared to die at sixty, you can pretty much scratch dementia off your list of things to worry about. By contrast, if you don’t mind being a bit dotty—or worse than a bit—you can go for longevity. But, unless you’re lucky, you won’t win both games.

Twenty years ago, I received a diagnosis of Parkinson’s disease. I was forty-three. (Michael J. Fox, since you ask, was only thirty when he got the bad news.) After several weeks of quietly freaking out, it occurred to me to wonder whether it would affect my brain. I already knew that this was not the right question. Parkinson’s is completely a brain disease, unlike, say, multiple sclerosis, which causes more widespread damage. But I knew what I meant and you know what I mean. Would it affect my ability to think? I already knew the answer to that one, too, really. One of the tricks many people learn is that, if you’re stuck in a chair and can’t get up, you imagine yourself getting out of the chair, and then usually you can do it. So I knew that thinking was involved. I asked my neurologist at the time, and he answered carefully, “Well, after a few years you may lose your edge.” Lose my edge? Lose my edge? Oh, shit! I need my edge. My edge is how I make a living. More than that: My edge is my claim on the world. It’s why people are my friends, why they invite me over for dinner, perhaps why they marry me. What am I worth to the world if I’ve lost my edge?

Gradually, I calmed down. My physical symptoms seemed to be advancing quite slowly. Even after twenty years, if I take my meds I can seem almost symptom-free for most of the day. Sometimes I imagine that I feel my edge dulling, but usually I feel—ominously like those people in the comic book—that nothing has changed. Recently, a standard-issue baby-boomer bad back has been more burdensome to me than Parkinson’s. You’d think that if you’ve been assigned a major health issue you’d get a pass on the minor ones. But it doesn’t work that way.

Meanwhile, my neurologist—a brilliant and warmhearted man, in his thirties, with a family—died of a brain tumor. So you never can tell. You can’t even be entirely certain that a diagnosis of Parkinson’s is correct until your brain is sliced open at an autopsy, and, frankly, I’ve never been curious enough for that. But I still retain the tiny, irrational hope that the whole thing will turn out to have been a terrible mistake (for all the good it would do me at that point).

But even if I don’t feel any dumber—or at least I don’t feel I’m getting dumber any faster than my boomer friends—does that mean I’m not? Do you know when you’re losing it, like the computer HAL, in “2001: A Space Odyssey”? “I’m afraid, Dave. Dave, my mind is going. I can feel it. I can feel it. My mind is going. There is no question about it. I can feel it. I can feel it.” Or is being demented, even mildly, like having a sign on your back that everyone can read except you?

In any event, a neurologist friend says I’m an “outlier,” and that means I’m very lucky. When I’m blue, I also look to role models for inspiration. Did you know that neurologists generally believe that Hitler had Parkinson’s? Francisco Franco and Mao Zedong both probably did, too. What a trio! These men were demented, to be sure, but not in the way your mother or grandmother is (let’s hope). It surely must require a superior intellect to be a Fascist dictator (unless you inherit the job, like Bashar al-Assad or Kim Jong-un). Other famous parkinsonians include George Wallace, Enoch Powell, and Pierre Trudeau. All had big personalities, if that is part of what my doctor meant by “edge.” Then there’s Pope John Paul II and Michael J. Fox. And how about this one: Thomas Hobbes! He wrote “Leviathan” with the help of secretaries, years after his diagnosis. Is it just a coincidence, I ask you, that both Hitler and Franco were nasty, brutish, and short? Chairman Mao was five feet eleven. Michael J. Fox is neither nasty nor brutish but he is undeniably short.

All in all, it’s an impressive list. The law of averages does not decree that in any random group of millions of people one or two will turn out to be Fascist dictators. In the 2011 book “The Cognitive Neuropsychiatry of Parkinson’s Disease,” Patrick McNamara, a neurologist at Boston University, writes, “PD, apparently, does not prevent creative work of a very high intellectual caliber.”

After some reflection, I concluded that as long as I still felt infallible Parkinson’s would not stop me from continuing to pursue my dream of becoming Pope. The years passed. I got married, went to work for Microsoft, and concluded that any changes in my cognitive ability were pretty minor, and progressing slowly enough so that the truck with my name on it is almost certain to arrive first.

But in the two decades since I got my diagnosis, there has been a revolution in thinking about this still mysterious disease. Parkinson’s has always been classified as a “movement disorder.” People shake uncontrollably, or they freeze trying to go through a doorway, or they slow down and shuffle when they walk. Mental problems as such were thought to arise only sometimes, after many years.

Neurologists now believe that defects (or, as they put it tactfully, “deficits”) in cognition, memory, and so on can predate the physical symptoms that lead to the diagnosis. The medical journals are full of articles with titles such as “The Neglected Side of Parkinson’s Disease” and “Parkinson’s Disease: The Quintessential Neuropsychiatric Disorder.” The non-movement-related symptoms are usually not helped by levodopa, the miracle drug that revolutionized Parkinson’s treatment in the nineteen-sixties and remains what neurologists like to call the “gold standard.” It is the most common drug that works clearly for most people with Parkinson’s symptoms, at least for a few years. But now there is some evidence that levodopa can make the non-motor symptoms worse.

McNamara summarizes the current view in a way that other neurologists I’ve asked, without endorsing it a hundred per cent, say is fair: “Neuropsychiatric disturbances of Parkinson’s disease . . . can be as disabling as the motor symptoms of the disease. . . . Upwards of 85% of PD patients evidence deficits in executive cognitive functions even early in the disease.” He says:

Almost half of all patients progress toward a dementing illness that may occur late in the disease. More than half of all patients suffer severe anxiety or depression. Roughly 50% of patients suffer varying degrees and types of apathy, hallucinations, sleep disturbance, and impulse control disorders.

I’ll stop there, if you don’t mind.

Many neurologists believe that there is something identifiable as a “parkinsonian personality.” A 1999 article in the European Journal of Neurology, about Hitler’s Parkinson’s, declares flatly, “It has been proved that Adolf Hitler suffered from idiopathic Parkinson’s disease.” Idiopathic means doctors have no idea why someone got it, but it wasn’t from getting hit too often on the head. Hitler had “the typical premorbid personality of parkinsonian patients with uncorrectable mental rigidity, extreme inflexibility and insupportable pedantry.” This works both ways: more people with Parkinson’s display these unattractive traits, and more people with these traits have Parkinson’s, or will get it. McNamara piles on. People with Parkinson’s have been described as “socially withdrawn, rigid, punctilious, serious, stoic, introverted and uninterested in others.”

But enough about him. Let’s talk about me. To me, this doesn’t sound like me at all. Still, how can I know? Maybe he’s got me nailed, but the nature of these traits makes me incapable of recognizing that I’ve got them. No pedant thinks he’s a pedant.

There is a simpler explanation of why someone with the physical symptoms of Parkinson’s and the knowledge that he is inexorably getting worse might feel depressed and anxious. But this, apparently, is not a field where Occam’s razor cuts much ice.

McNamara declares, “PD patients are impaired. . . . They have difficulty making decisions, developing plans . . . and monitoring and adjusting plans and actions.” Is it healthy skepticism or an unhealthy mental defect that makes it hard for me to take some of this seriously? He reports a study showing an “apparent willingness” among a subgroup of Parkinson’s patients “to associate with a socially untrustworthy individual,” along with its near-opposite, a tendency of parkinsonians generally to avoid risks and social interaction, and he attributes both to failures in “mentalizing abilities” (otherwise known, I believe, as thinking).

McNamara concludes his discussion of the various “deficits” in the parkinsonian mind with a little pat on the brain: “My own feeling is that PD patients tend to be exceptionally intelligent individuals.” Unfortunately, he says, “there are no controlled studies that can yet support this claim.” How could so few experts have noticed until the past two decades that Parkinson’s is as much about cognitive problems as it is about physical ones? In fact, there are three categories of Parkinson’s symptoms. There are physical symptoms, cognitive ones, and psychiatric ones—depression, anxiety, and so on. But even the latest edition (2012) of “Neuropsychological Assessment,” the leading text on this topic, says, “Parkinsonism’s outstanding feature is a movement disorder.”

The explanation is partly that the motor effects usually become evident before the mental ones, and partly that Parkinson’s is usually a disease of old people, who tend to die—of Parkinson’s or, more often, of something else—before the mental effects have time to flower. Or they are given a misdiagnosis of Alzheimer’s or another kind of dementia.

Not that I’m complaining. Widespread ignorance about the disease has served me well. One of the worst aspects of Parkinson’s (and I suspect this is true of other chronic diseases, especially those affecting the brain) is the fact that everybody around you knows you have it. Although they are well meaning, their sympathy can be excruciating. (I’m sure mine is, too, when the situation is reversed.) On top of everything else, some physical symptoms of Parkinson’s—rigidity, tremors, a blank expression (facial masking, it’s called), a stooped posture, slow movements, and others—make you look a bit demented even when you’re not. Slurred speech, another symptom, doesn’t help, either. All of this is why I chose, like many, to keep my medical problems under my hat until the symptoms became undeniable. In my case, that was about eight years. And as the cognitive effects of Parkinson’s become better known I intend to change the subject ruthlessly.

Several years ago, when I was running the opinion pages of the Los Angeles Times, I found myself in a public dispute with a local activist who believed (correctly) that there were too few women on the paper’s op-ed page. In the course of a heated exchange of e-mails, she suggested that Parkinson’s was affecting my brain. At that point, the battle was over and I had won. It was a horrible thing for her to say, even if there could have been some truth in it. That’s “some,” not a lot. Among those rushing to my defense was a George Washington University law professor who said that everybody knows Parkinson’s is a movement disorder and has little to do with your mental capacity. Even then, I could have corrected him, but I didn’t.

For twenty years, whenever I heard anyone talking about Parkinson’s and cognition, I’d be shrieking inwardly, “Shut up! Shut up. Shut up! Have you lost your mind?” Now here I am doing it myself. Have I lost my mind? Well, that is what we’re here to find out.

Unlike Alzheimer’s, Parkinson’s does not necessarily lead to mental problems. Neurologists believe that people who get Parkinson’s at an earlier age are less likely to suffer cognitive problems. The fact that I’ve had it for twenty years can be argued either way: that my luck won’t hold much longer or that I have a slow-advancing case and don’t need to worry especially about it.

There is also something called mild cognitive impairment, or MCI. Many people with mild impairment from Alzheimer’s or Parkinson’s lead reasonably normal lives. They may not be able to explain the regulations about preëxisting conditions under Obamacare, but they can write perfectly pleasant editorials about the coming of spring and even subtly gloating obituaries about people who’ve died of something else. A writer’s work, unlike that of most professionals, is judged on its own merits. If you write a good book, or even a good book review, the assigning editor needn’t care about the present or future state of your cognitive ability.

Another difference between Alzheimer’s and Parkinson’s is that Alzheimer’s tends to start its destruction in the parts of the brain affecting memory, whereas Parkinson’s starts with what they call the executive function: analyzing a situation and your options and making a decision. I’ve asked several neurologists whether the executive-function problem is wrong decisions or slow decisions or no decisions. The clearest answer I ever got was all three. Some people think that this is where the physical effects of Parkinson’s and the mental effects tend to merge: you just generally slow down. Does it take me longer to write a column than it used to? Maybe. That doesn’t bother me much. But if I couldn’t reach a conclusion, or tended to reach the wrong one (leaving aside those people who think I’ve been reaching the wrong conclusion all my life), I would find that quite distressing.

I felt that I needed to know. So I decided (decision crisply made and executed, please note) to have myself tested. Should I still be going for the gold and plotting to take over the New York Times? Or should I be looking for a place in the sunshine and taking up golf? Or should I be searching for a good nursing home? My motive was part scientific inquiry, part hypochondria, and part the journalist’s reaction to any interesting development—“This would make a great piece.”

A cognitive assessment is basically like a physical, only it’s testing your mind, not your body. The challenge is that the doctor can’t just poke around your brain saying, “Where does it hurt?” Defects in your thinking must be deduced from the brain’s performance. So a cognitive assessment, which can last four or five hours or more, is a series of quizzes, puzzles, and games.

In what’s called the Counterfactual Inference Test, cited and discussed in McNamara’s book, we meet Janet and Susan, who are having a rough day. “Janet is attacked by a mugger only 10 feet from her house. Susan is attacked by a mugger a mile from her house. Who is more upset by the mugging?” Your choices are (a) Janet, (b) Susan, or (c) same or can’t tell.

The test is supposed to measure your ability to imagine alternative scenarios as part of making rational decisions. Besides Janet and Susan, the Counterfactual Inference Test introduces us to other victims of modern life, such as Jack, who misses his train by only five minutes; Ann, who gets sick in a favorite restaurant; and so on. The cognitive assessment I took in November didn’t include Janet, Susan, and their friends. But it included many similar tragic figures.

To me, the answer is obviously (c): How can you possibly answer the question of which woman was more upset without knowing more about Janet, Susan, and the circumstances of their muggings? Who is more upset? That depends on all sorts of factors, among which the distance from the mugging victim’s home is not even the most important.

Please note that the question is not “Who is likely to have been more upset?” or even “Who ought to be more upset?” It’s who actually was more upset. Without more information—or without assuming, implausibly, that Janet and Susan are exactly alike, and that the circumstances of their muggings are exactly alike except for the distance from their homes—it is impossible to know who is more upset. Should we assume that both Janet and Susan have average temperaments? That both are the same age, carry similar amounts of money in their purses, have been mugged before—or have not been mugged before? Did either mugger carry a knife or a gun? Did Janet or Susan carry a knife or a gun?

Any number of factors would go into determining someone’s reaction to being mugged. No doubt, if you wanted to plot every mugging in the past year on a graph, with distance from home along one axis and degree of upset along the other (though I can’t imagine why you would do this—are you crazy?), you could generate a nice scatter diagram showing a positive correlation between the distance of a mugging from someone’s house and how upset that person gets when she is mugged. That said, what have you accomplished? There is a positive correlation between any number of things about a mugging and how upset a Janet or a Susan gets.

Every case is unique. For example, what if Janet is actually Janet Yellen, the chair of the Federal Reserve Board? Maybe she was walking around with M1 for Q2 in a Trader Joe’s bag when she got mugged. Isn’t she entitled to government protection? Where the hell was it? She might get very upset even if she was many miles from her house. And rightly so!

Is all this just quibbling? I don’t think so. I can see perfectly well that the authors of this test are pushing me to choose (a) Janet. A mugging close to your house is scarier than a mugging farther away. I get it. But does that make (a) the right answer? Or is (a) what, in the world of mental testing, is called a “distracter” and in the real world “sucker bait”? The purpose of a distracter is to tempt you into a cul-de-sac of logical error.

To answer the question correctly—or, more precisely, to give the people who write the questions the answer they want—you need to peer inside the brains of many people. Not just Janet and Susan but also the people who write the questions. You have to ask yourself not “What is the right answer to this question?” but, rather, “What do they think is the right answer?” Or “What do they want me to think is the right answer?” Answer: the answer they want is (a) Janet.

This seems so obviously wrong to me that it’s scary, like something out of “One Flew Over the Cuckoo’s Nest,” if not “1984.” (“Janet is more upset about being mugged, Winston. Janet has always been more upset about being mugged.”) However, there’s a problem. Eighty-six per cent of a control group took the easy—but, in my opinion, clearly erroneous—way out and voted for Janet as “more upset.” By contrast, seventy-one per cent of the group being studied shared my view that “same or can’t tell” is the right answer.

This leaves me with some explaining to do. I’m perfectly willing to believe, on almost any subject, that I’m right and a majority of other people are wrong. That’s more or less been the basis of my writing career. But how do I explain the glaring disparity in judgment between the control group and the subject group? I have no explanation. The doctors do. Apart from agreeing with one another and disagreeing with most other people about how seriously to take a mugging, members of the group being studied had only one thing in common (with one another and with me): Parkinson’s disease.

When I decided to have myself tested, I tracked down Mark Mapstone. Twenty years ago, when I panicked about losing my edge, I volunteered to be a guinea pig in a study being done at M.I.T. Mapstone was working as one of the test administrators. I remember vividly that he said, about Parkinson’s, trying to be sympathetic, “It’s a terrible disease”—just as I was on the verge of convincing myself that it wasn’t such a terrible disease. Nevertheless, we hit it off.

Twenty years later, I found Mark at the University of Rochester, where, as an associate professor, he is still doing “neuropsychological assessment”—that is, administering and interpreting these games and puzzles. He seemed glad to hear from me and excited at the prospect of comparing my results from twenty years ago with my results today. Unfortunately, the twenty-year-old results seem to have been shredded somewhere along the way. But I also took the test twice eight years ago, before and after deep-brain-stimulation surgery, and I was able to obtain those results.

The neuropsychological effects of deep-brain-stimulation surgery, it turns out, is one of Mark’s special areas of interest. In DBS, doctors install pacemakers in your chest and run wires to your brain in order to . . . do something or other. For me, this surgery has been a miracle in terms of reducing the physical symptoms of Parkinson’s. Mark’s research, though, suggests that the surgery affects your “working memory,” which is the brain function that temporarily stores and manipulates information needed for various cognitive tasks. Oh, well. Where were we?

Obviously, you are expected to do the best you can on the cognitive tests, but it’s not supposed to be a contest. There’s no opponent, and there’s no point in cheating. The purpose is to get as clear a picture as possible of your cognitive strengths and weaknesses. Still, my attitude was “Screw all that. I’m going to ace this exam, even if I have to cheat to do it.”

And I did cheat—or I tried. In one exercise, you’re asked to name as many items as possible in some general category, in a limited period of time. In my hotel room in Philadelphia the night before the test, I Googled a list of fruits and vegetables, which were the categories twenty years ago, at M.I.T. I read the list several times that evening, and again at breakfast. Unfortunately, this time the test used animals instead of fruits, so that clump of brain cells was wasted. Another test involved guessing something about the next card in a stack as the tester turned the cards over, one at a time. There was a trick to this one that made the test easy once you figured it out. I had figured it out twenty years ago, and I remembered the gimmick. I said nothing when the tester pulled out her cards, but I put my cards on the table after the test was over. The testers were so impressed by my retention of this memory that they mentioned it twice in their report. Unfortunately, they also noted that though I knew the trick I still scored badly.

I have to be a little vague about the details of these games, because I promised as much to Mark Mapstone. Some people, apparently smarter and/or less scrupulous than I am, have been known to take advantage of foreknowledge about them, thus distorting the result. This is less of a problem than you might think, because some people taking the test want to do badly. They’re hoping to qualify for early retirement on disability. What brain snobs we are, or at least I am. Here I was trying desperately to demonstrate that my brain was in working order (even if it wasn’t), while most people were quite sensibly happy to be thought mentally disabled (even if they weren’t) if that meant a pile of money from the government and early retirement.

Whenever I have subjected myself to these cognitive puzzles, I have been struck by how reductive they seem to be and yet how much weight is given to the result. Neuropsychologists really believe that wrong answers to a few questions involving the alphabet demonstrate personality traits and mental abilities (or disabilities) that run deep.

I would like to say that the whole thing is a fraud. But I can’t explain why Parkinson’s patients and similar groups seem to travel in packs. They might have the right answer or they might have the wrong answer, but they have the same answer, and it’s different from the answer that most “normal, healthy” people have. That’s weird. The neuropsychologists say it’s because Parkinson’s patients share a mental defect of some kind. I don’t care for that explanation. But I have no other explanation. And you can’t beat a horse with no horse. So I have reluctantly concluded that there must be something to all this stuff after all. That made the results of my long morning of cognitive testing, which I received by mail a couple of weeks later, a bit disturbing.

I’ve tried to explain it away, with mixed success. When I took the test, I was answering questions, moving pieces of cardboard around, drawing various shapes with a pencil, and so on, for about five hours. The testers offered me a break, and I foolishly turned it down. Approaching the end, I was feeling tired—and bored, and impatient. This is evident in my scores on the various tests, which start out high enough, but then go sharply downhill. Reflecting on this afterward, I felt strongly that the last hour or so shouldn’t count, or that I should be allowed to take those parts again. It turns out, however, that perseverance is a cognitive trait and one of the things that are being tested. My increasingly random stabs at the right answer as the ordeal came to a close were held against me. The fact that I didn’t feel like persevering is my problem, not the test’s or the testers’.

So how did I do over all? Bottom line: not bad, but not great. When I took the tests eight years ago, after my DBS surgery, I was “off the charts,” as Mark Mapstone said, in nearly every category. This time, I did poorly in exactly the categories where someone who’s had Parkinson’s for twenty years would be expected to do poorly.

The summary of my performance starts out pleasantly: “Mr. Kinsley is a highly intelligent, friendly, and engaging 62-year-old man . . . IQ in the Very Superior Range . . . excellent cognitive reserve . . . exceptionally strong vocabulary. . . . His drawing of a clock was fully intact.” Yes, they ask you to draw a clock. I did well on that one.

That business about “a tendency to break task rules” does not mean that the testers caught me Googling for answers. All I did was move a piece of a puzzle to see how that changed things, before moving it back. I had no intention of keeping it in the wrong place. I was always going to move it back. Honest! Anyway, they never said you couldn’t move the damn pieces. Or maybe they did say it. Who can remember?

Most unnerving of all was a throwaway line: “In addition, his insight concerning his cognitive weaknesses seemed quite limited.” That is a game I cannot win. If I deny any cognitive problems, it just proves that I have them. How unfair is that? They are implying that I don’t really want to know the truth. Is that true? Yes, of course it’s true. But do they have to rub it in? Anyway, they’re confirming that I’ve got that sign on my back, or I’m the hammer that’s trying to mend itself. I’m the postage stamp that doesn’t realize it’s lost a dimension.

Reviewing my actual test scores was a humbling, if not horrifying, experience. My I.Q. is fine (and none of your business), thank you, but some of the other numbers tell a different story. They start out in the nineties but then sink. I don’t know what tests these scores even refer to, but I don’t like them anyway. I’m not used to numbers like 37, 25, 14, 5, 2 . . . A 2? You’ve got to be kidding. These are bad numbers. A 2 means that on some test or other I did worse than ninety-eight per cent of the population, adjusted for age and education. I look out my office window at the rush-hour crowds: are they telling me that if you scooped up a hundred people at random and gave them the test that I got a 2 on, ninety-eight of them would do better than me? Geezus.

Mark Mapstone was surprisingly hard-line when I appealed to him on the accusation that I “broke task rules” by moving a piece of a puzzle—even though I was going to put it back, honestly, and just wanted to see . . . well, you know. Mark said, “You knew what the rule was. You should have made that decision before initiating movement. One thing we’re looking for is impulse control. Putting action before thinking is the kind of error you made. You did something and then thought about it. That’s less efficient and less elegant than planning a strategy.”

About my condition in general, Mark said, “People who receive a diagnosis in their forties and are now in their sixties—this is absolutely what we would expect to see. If I didn’t see this, I would be surprised. In a patient who gets the diagnosis at sixty-five or seventy, you would expect to see these symptoms within five years.” Mark is a Ph.D., not a medical doctor, but he shares one trait with many M.D.s. Although doctors are devoting their lives to helping people get better, they seem to find a strange satisfaction in seeing a disease take its expected course. “That’s perfectly normal,” they say. “It’s what we would expect.”

So what’s my prognosis? Parkinson’s is a degenerative disease, so things are not likely to get better. But they’re really not so bad now. How bad could a symptom be if it takes a five-hour test to find it? Mark Mapstone says, “In general, I think that if one looks hard enough it’s possible to find deficits in many people, presumptively cognitively normal or otherwise. Understanding the brain mechanisms of cognitive diversity and how to fix them when they break is what pushes us forward.”

Mark was blunt about my low scores in important areas. “Anything from 25 to 75 is considered normal, and that covers many of your low scores, but someone like you, who was doing 95 or 98 eight years ago, normally should be doing better.” As for the 5s and 2s, those represent real deficits.

The politically correct line on intelligence (or, as we say in neurology, cognition) is that it’s not a single thing—I.Q.—but, rather, a collection of talents and abilities that we all have in different amounts. People say this, but I’m not sure how many actually believe it. The notion that intelligence is a number, a place somewhere on the spectrum from smart to stupid, is just too deeply rooted. We say, “She’s as sharp as a tack,” or “You’re not too smart, are you? I like that in a man” (Kathleen Turner, in “Body Heat”). Nobody I know says, “She’s great at counterfactual inference, but not so great at naming fruits.”

What we’re learning from the study of cognition is that the P.C. view is closer to the truth. There are all sorts of things going on in our heads—and I mean our physical heads, not our minds—that affect how we act or even who we are. This extreme mechanical view can be depressing. That edge that I’m so vain about is just an extra spritz of some chemical in my brain? But the mechanical view is comforting, too. It says that each of us is a collection of mental strengths and weaknesses: “normal” people as well as people with chronic degenerative neurological diseases. And weaknesses can be overcome, to some extent, by strengths somewhere else.

People understand this about physical disabilities. Someone with a broken leg will not, for that reason alone, be denied a job that requires him to type. We are comfortable with the idea that physical health is not just a single number but a multiplicity of factors. That’s where we need to arrive about mental problems. As we get older, we’re all going to lose a few of our marbles. As the word gets out that Parkinson’s disease is not just a movement disorder, there will be people whose careers will be destroyed because, on a particular day at a particular time, they can’t recite a seven-digit telephone number backward. Allowing someone’s fate to depend on whether he or she can do well on some stupid test is just the reductio ad absurdum of the meritocratic machinery that has been pretty good to me (and to you, I suspect) over most of a lifetime.

Years ago, when I was the editor of Harper’s, we employed a “mentally retarded” (as the term was back then) man named Joe as our “office boy” (as the term was back then). He sorted the mail, ran simple errands, and so on. One day, I went to the stockroom in search of “typing paper” (as the term was back then). I opened the supply cabinet and stared at the contents but didn’t see what I was looking for. Joe was there, and I asked him, “Hey, Joe, are we out of typing paper?” He pointed to a ream at eye level. “Gosh,” I said. “How in the world did I miss that?”

Joe smiled sweetly and said, “Don’t worry, Mike. It happens to me all the time.” ♦